Coagulation Case Studies
Thursday, June 4, 2009
A 42 year old female presents with symptoms of a DVT, this is her second episode.
Currently she is on oral contraception. Family history includes maternal grandmother died from a stroke at the age of 50, and mother presented with a DVT at the age of 55 after being placed on hormones for menopause.
Patient test results as follows:
PT = 10.1 (10-12 sec)
APTT = 26.1(26-36 sec)
What tests should be ordered?
Screening tests are normal, since this is her second episode, and their is a family history, testing for thrombophilia should be performed- such as Protein C, S, ATIII, Factor VIII, and Activated Protein C resistance.
Should Genetic testing be done? Most likely it should be done, but initially the patient needs to be treated regardless of the cause.
Should this patient be removed from OC? Since it is a second episode that appears to be unprovoked, it looks like the patient should be removed. Otherwise, Depending on the patients results, as well as their other risk factors, (smoking,sedentary, obese,)
What would you do?? I would not take OC since there is a recurrance of VTE, patient should be advised to exercise and be aware of their weight.
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